Selecting the right accessories for your ventilator

In the intricate realm of mechanical ventilation, selecting the right breathing circuit components is paramount for ensuring the well-being of patients. From adults to neonates, each demographic requires tailored components. This guide explores the key elements, such as breathing circuits, HME filters, bacteria filters, nebulization, and other accessories, shedding light on the considerations vital for healthcare professionals.

Breathing Circuits

this plays a vital role in the overall accuracy of breath delivery to the patient. Usually, machines from most of the manufacturers are calibrated on specific breathing circuits, hence it is highly recommended to use the breathing circuit provided by the manufacturer or if a third-party breathing circuit is being used it should be as per manufacturer recommendations. Below are the important elements of the circuit –

Here is a standard table with details recommended by one of the leading manufacturers

Here are some points to be considered while selecting the right option:

• Length of tubing for mobility and positioning.
• Compatibility with the chosen ventilation mode.

HME Filters (Heat and Moisture Exchange)

The HMEF is a passive humidification component used together with a bacteria filter. Use an HMEF when ventilating with a coaxial breathing system. It maintains humidity levels in inhaled air and reduces the risk of infection by filtering out bacteria and viruses.

Here are some points to be considered while selecting the right option:

• Choosing appropriate HME filter size based on patient age.
• Monitoring filter efficiency over time and replacing as needed.
• Recognizing the balance between humidity preservation and minimal added resistance.

Inspiratory Bacteria Filter

The necessity to use an inspiratory filter depends upon the distinctive design of the machine’s pneumatics and the manufacturer’s recommendation. However, even if the manufacturer doesn’t declare it mandatory to use, one can choose to use one based on the institution’s protocol. If the machine has a way to prevent the contamination of the inspiratory port the filter becomes unnecessary. One should keep a close watch for any signs of increased circuit resistance if a bacteria filter is being used.

Here are some points to be considered while selecting the right option:

• Selecting filters with high bacterial filtration efficiency.
• Ensuring compatibility with the ventilator and breathing circuit.
• Regularly replacing filters to prevent contamination risks.

Expiratory Bacteria Filter

An expiratory filter is generally not a mandatory component for any ventilator, though you can choose to use one following your institution’s guidelines.  Should you opt to use an expiratory filter, position it on the patient’s side of the expiratory valve cover. Pay close attention to detect any signs of increased resistance in the expiratory circuit. Additionally, an “Exhalation Obstructed” alarm may also be triggered in case of excessive expiratory circuit resistance. If this alarm repeats frequently, promptly remove the expiratory filter. If you suspect increased resistance in the expiratory circuit for any other reason, consider removing or replacing the filter to eliminate it as a potential cause

Here are some points to be considered while selecting the right option:

• Selecting filters with high bacterial filtration efficiency.
• Ensuring compatibility with the ventilator and breathing circuit.
• Regularly replacing filters to prevent contamination risks.

Nebulization

Function: In some ventilators, the manufacturer provides the option of inline nebulization. The major function of this inline nebulization is to administer the medication directly to the patient’s airways without disconnecting the patient.

Here are some points to be considered while selecting the right option:

• Compatibility with the chosen ventilator and breathing circuit.
• Choosing between active and passive nebulization systems.
• Monitoring nebulization efficiency and adjusting settings as necessary.

 Other Accessories

• Circuit Mounts and Holders
• Pressure Manometers
• Expiratory Limb Sensors

Here are some points to be considered while selecting the right option:

• Proper positioning and secure attachment of circuit mounts.
• Regular calibration of pressure manometers for accurate readings.
• Utilizing expiratory limb sensors for enhanced monitoring.

The selection of breathing circuit components is a nuanced process that demands a deep understanding of patient demographics, ventilation requirements, and infection control. By carefully choosing and maintaining these components, healthcare professionals can optimize the mechanical ventilation process, ensuring patient comfort, safety, and overall positive outcomes in diverse clinical settings.